This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The primary objective of the DPPOS is to evaluate the long-term effects of active DPP interventions on the development of a ) diabetes during a further 5-10 years of follow-up and b) composite diabetes-related microangiopathic and cardiovascular disease outcomes. The hypotheses being tested are that both the continued lifestyle intervention and metformin will provide continued separation in the rates of diabetes development, compared with the former placebo group, and that the prevention or delay of diabetes during the DPP and DPPOS will translate into reduced rates of composite outcomes and improved health status.